Perry Ashley M, Brunner Andrew M, Zou Tao, McGregor Kristin L, Amrein Philip C, Hobbs Gabriela S, Ballen Karen K, Neuberg Donna S, Fathi Amir T
Massachusetts General Hospital, Boston, Massachusetts.
Dana-Farber Cancer Institute, Boston, Massachusetts.
Cancer. 2017 Jul 1;123(13):2561-2569. doi: 10.1002/cncr.30639. Epub 2017 May 2.
Chronic myeloid leukemia (CML) can be treated effectively with tyrosine kinase inhibitor therapy directed at BCR-ABL, but access to care, medication cost, and adherence may be barriers to treatment. This study was designed to determine whether the insurance status at diagnosis influences CML patient outcomes.
The Surveillance, Epidemiology, and End Results database was used to identify 5784 patients, aged 15 years or older, who were diagnosed with CML between 2007 and 2012 and whose insurance status was documented at diagnosis. The primary outcome was 5-year overall survival (OS). Covariates of interest included the age at diagnosis, race, ethnicity, sex, county-level socioeconomic status, and marital status. OS was evaluated with a log-rank test and Kaplan-Meier estimates.
Among patients aged 15 to 64 years, insurance status was associated with OS (P < .001): being uninsured or having Medicaid was associated with worse 5-year OS in comparison with being insured (uninsured patients, 72.7%; Medicaid patients, 73.1%; insured patients, 86.6%). For patients who were 65 years old or older, insurance had less of an impact on OS (P = .07), with similar 5-year OS rates for patients with Medicaid and those with other insurance (40.2% vs 43.4%). In a multivariate analysis of patients aged 15 to 64 years, both uninsured patients (hazard ratio [HR], 1.93; P < .001) and Medicaid patients (HR, 1.83; P < .001) had an increased hazard of death in comparison with insured patients; patients younger than 40 years, female patients, and married patients also had a lower hazard of death.
These findings suggest that CML patients under the age of 65 years who are uninsured or have Medicaid have significantly worse survival than patients with other insurance coverage. Cancer 2017;123:2561-69. © 2017 American Cancer Society.
慢性髓性白血病（CML）可通过针对BCR-ABL的酪氨酸激酶抑制剂疗法得到有效治疗，但获得医疗服务、药物成本和依从性可能成为治疗的障碍。本研究旨在确定诊断时的保险状况是否会影响CML患者的预后。
利用监测、流行病学和最终结果数据库，识别出5784例年龄在15岁及以上、于2007年至2012年间被诊断为CML且诊断时保险状况有记录的患者。主要结局为5年总生存率（OS）。感兴趣的协变量包括诊断时的年龄、种族、民族、性别、县级社会经济状况和婚姻状况。采用对数秩检验和Kaplan-Meier估计法评估OS。
在15至64岁的患者中，保险状况与OS相关（P < .001）：与参保患者相比，未参保或参加医疗补助计划的患者5年OS较差（未参保患者为72.7%；医疗补助计划患者为73.1%；参保患者为86.6%）。对于65岁及以上的患者，保险对OS的影响较小（P = .07），参加医疗补助计划的患者和参加其他保险的患者5年OS率相似（40.2%对43.4%）。在对15至64岁患者的多变量分析中，与参保患者相比，未参保患者（风险比[HR]，1.93；P < .001）和医疗补助计划患者（HR，1.83；P < .001）的死亡风险均增加；40岁以下的患者、女性患者和已婚患者的死亡风险也较低。
这些发现表明，未参保或参加医疗补助计划的65岁以下CML患者的生存率明显低于参加其他保险的患者。《癌症》2017年；123:2561 - 69。© 2017美国癌症协会。
